Arthroscopic release for lateral epicondylitis: A cadaveric model

At least 10 different surgical approaches to refractory lateral epicondylit is have been described, including an arthroscopic release of the extensor c arpi radialis brevis tendon. The advantages of an arthroscopic approach inc lude an opportunity to examine the joint for associated pathology, no disru ption of the extensor mechanism, and a rapid return to premorbid activities with possibly fewer complications. A cadaveric study was performed to dete rmine the safety of this procedure. Ten fresh-frozen cadaveric upper extrem ities underwent arthroscopic visualization of the extensor tendon and relea se of the extensor carpi radialis brevis tendon. The specimens were randomi zed with regard to the use of either a 2.7-mm or a 4.0-mm 30 degrees arthro scope through modified medial and lateral portals. Following this, the arth roscope remained in the joint, and the portal, cannula track, and surgical release site were dissected to determine the distance between the cannula a nd the radial, median, ulnar, lateral antebrachial, and posterior antebrach ial nerves, and the brachial artery and the ulnar collateral ligament. No d irect lacerations of neurovascular structures were identified; however, the varying course of the lateral and posterior antebrachial nerves place thes e superficial sensory nerves at risk during portal placement. As in previou s reports, the radial nerve was consistently in close proximity to the prox imal lateral portal (3 to 10 mm; mean, 5.4 mm). The ulnar collateral ligame nt was not destabilized. Arthroscopic release of the extensor carpi radiali s brevis tendon appears to be a safe, reliable, and reproducible procedure for refractory lateral epicondylitis. Cadaveric dissection confirms these f indings.